Brownsville Texas Healthcare Fraud Defense Attorneys
Brownsville Healthcare Defense
Team Lead
Contact NickBrownsville, Texas healthcare providers, entities, and businesses have a high risk of being investigated for healthcare fraud by the federal government. Oberheiden, P.C. has extensive experience in:
- Healthcare fraud defense,
- Medicare and Tricare audits,
- Protection of assets,
- Compliance programs,
- Jury trials,
- Fraud allegation defense,
- Qui tam defense,
- OIG and grand jury subpoenas,
- Criminal defense, and
- Internal investigations.
Our Healthcare Fraud Defense Team includes a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. Our Brownsville, Texas healthcare fraud defense attorneys proudly serve clients in Brownsville as well as throughout the state of Texas.
If you’re in Brownsville, Texas or the surrounding area and you’re under investigation by the federal government for healthcare fraud, call Oberheiden, P.C. Ask to speak with a member of our Healthcare Fraud Defense Team. The initial call is free and confidential.
Brownsville, Texas Is Constantly Scrutinized by the Federal Government
Brownsville, Texas is one of nine regions in the United States that is constantly watched by the federal government for healthcare fraud. The Medicare Fraud Strike Force is a team of federal prosecutors and investigators from various agencies. They monitor, investigate, and prosecute healthcare fraud.
Brownsville, Texas is watched because of the number of federal healthcare program beneficiaries who live in the area. This causes more claims to be filed for payment from the federal government. The increase in the number of claims makes the government believe there is a higher likelihood of healthcare fraud. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. OIG, HHS
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former DOJ Trial Attorney
Partner
Brian J. Kuester
Former U.S. Attorney
Hon. Kevin McCarthy
55th Speaker, U.S. House of Representatives (ret.)
Government Consultant
Mike Pompeo
Of Counsel
Former U.S. Secretary of State
John W. Sellers
Former Senior DOJ Trial Attorney
Linda Julin McNamara
Federal Appeals Attorney
Nicholas B. Johnson
Former Prosecutor
Roger Bach
Former Special Agent (DOJ)
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Ray Yuen
Former Supervisory Special Agent (FBI)
Defining Federal Healthcare Fraud
It’s important to understand what constitutes healthcare fraud. Healthcare fraud is defined as an attempt to receive payment from a federal government healthcare program for medical services or equipment from incorrect or fraudulent claims. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It incorporates at least one of the following elements:
- The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
- Stark Law. Stark Law is more commonly known as the Self-Referral Law. It bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
- False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act.
- Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
- Billing Fraud. One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates:
- Allegations of phantom billing (services not provided),
- Ghost patients (patients who do not exist), and
- Billing for medically unnecessary services or equipment.
- Certification Errors. The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.
Oberheiden, P.C. works to help clients avoid criminal charges that often result from healthcare fraud allegations. If you’re in Brownsville, Texas or the surrounding area, call us now. Your first call is free and confidential.
Civil and Criminal Penalties of Healthcare Fraud
Federal healthcare fraud can result in civil or criminal charges against you or your business. In civil court, you could be ordered to repay the amount of the federal claims, you may lose reimbursement for future claims, and you could be barred from future participation in federal healthcare programs.
Criminal penalties are extremely serious. You could be forced to pay huge fines, and you could even be sentenced to time in federal prison:
- Up to 10 years for each count of healthcare fraud,
- Up to 20 years for each count of fraud that resulted in serious bodily injury,
- Life sentence if the healthcare fraud resulted in death.
It is crucial to hire experienced attorneys to navigate the complexities of such federal criminal cases and mitigate potential penalties.
Often, we’re asked about the worst-case scenario for healthcare fraud for medical professionals, entities, and businesses in Brownsville, Texas. Whether or not you’ll face criminal charges or a prison sentence depends on several factors. These are: the severity of injury suffered by a patient, whether the prosecutor sees an advantage in pursuing criminal charges, and the reason why the federal government began the case. If you’re under investigation for healthcare fraud, contact Oberheiden, P.C. Your initial call is confidential and free.
Oberheiden, P.C. is ready to help Brownsville, Texas healthcare clients based on our dual experience as former federal prosecutors and fraud attorneys. If you’re contacted and told you’re under investigation for healthcare fraud, call us today. Learn more about your legal options and how we can help. Initial consultations are confidential and free of charge.
Is the Investigation Criminal?
Healthcare fraud investigations can be civil or criminal in nature. In fact, they often start out as civil investigations and turn into criminal ones. This is why it is important for you to contact Oberheiden, P.C. as soon as you are aware that you’re being investigated.
Healthcare fraud investigations in Brownsville, Texas can be civil or criminal. Investigations can start as civil and then become criminal as the investigation progresses. Being contacted by a prosecutor is not an indicator determining the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor as an indicator. Rather, signs of a criminal investigation may include:
- Search warrants,
- Seizure warrants,
- Arrest warrants,
- Target letters,
- Contact from a federal criminal prosecutor,
- Involvement from the IRS, or
- Receipt of a grand jury subpoena.
Frequently Asked Questions
Are healthcare fraud charges civil or criminal?
It depends on the nature and seriousness of the violation. Some federal healthcare fraud statutes can only result in civil liability. The Stark Law, for example, prohibits providers from referring a Medicare patient to any entity in which the referring physician has a financial relationship. The Stark Law is a civil statute, meaning it carries the possibility of significant fines and other sanctions, but not prison time. The Anti-Kickback Statute (AKS) is a criminal law. It carries a potential penalty of five years in prison and a fine of $25,000. If you are convicted under the AKS, you will be excluded from Medicare/Medicaid programs for at least five years. If you are under investigation for healthcare fraud, it is critical that you speak to a Texas defense attorney as soon as possible to understand your options.
What can a Brownsville, Texas federal healthcare fraud defense attorney do to help me?
A Brownsville federal healthcare fraud defense lawyer can help in many ways. If you are a healthcare provider and have learned you are under investigation or being audited by a federal agency, we should be your first call. The first step is to determine if there is any criminal exposure and, if so, try to eliminate it. Although civil cases are still very serious, criminal cases carry potential jail time, so these are always the primary focus of a good defense strategy. An experienced defense attorney communicates with federal investigators on your behalf to learn more about the allegations. At this point, your attorney will conduct their own investigation and look for weaknesses in the government’s case. For example, investigators frequently spend time on a few billing inconsistencies that don’t always evidence a wide-ranging fraud scheme.
What is a qui tam lawsuit?
The term “qui tam” refers to a whistleblower claim filed under the False Claims Act. The Act is unique among federal statutes as it allows a private citizen with knowledge of healthcare fraud to bring suit against a provider. Usually, the whistleblower first goes to the federal government with information to see if it wants to intervene. If so, the federal government takes over the investigation. If the federal government determines that more charges are appropriate, it may add them to the complaint. In other words, the government is not bound by the exact claims brought by the informant. If the federal government does not intervene, the informant is permitted to bring the case alone. Qui tam lawsuits are quite common because whistleblowers can recover up to 30 percent of the amount recovered in a lawsuit. At the same time, this gives informants perhaps too much incentive to come forward with suspect evidence. If you recently learned that someone is accusing you or your practice of healthcare fraud, contact a Brownsville, Texas healthcare fraud defense attorney now.
Defenses for Healthcare Fraud Allegations
Oberheiden, P.C. provides defenses for healthcare fraud allegations to individuals and companies in Brownsville, Texas and the surrounding areas. Many of our Brownsville, Texas healthcare fraud defense lawyers have experience as healthcare auditors and healthcare fraud prosecutors with the Department of Justice and with the Medicare Fraud Strike Force. We use this experience to develop the proper legal defenses for each of our clients.
Immediate legal advocacy. The main objective of our law firm is to help our clients avoid criminal charges. We’ve learned the most effective way to do this is to promptly contact the federal government to begin advocating for our clients. This provides less time for the government to investigate you without interruption. This is important because when there is a long period of undisturbed time, you may face criminal allegations. After we are retained, we immediately reach out to make contact with the federal government. Within hours, we can usually get answers to these important questions:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
Proving lack of criminal intent. The government must prove that you committed a federal crime and that you acted with criminal intent. They must present evidence that meets a high legal standard. Often, the federal government will try to use billing inaccuracies to prove that you committed a crime. We’ve found that billing errors usually don’t occur because someone acted with criminal intent to defraud the government. They happen because of a mistake. Mistakes should certainly be corrected, but they should not lead to criminal conviction. The most common errors that cause problems include:
- Hiring unqualified workers,
- Delegation errors,
- Outsourcing errors,
- Lack of oversight,
- Insufficient supervision, and
- Frequently changing laws and rules in healthcare billing.
Choosing strategic legal defenses for each case. Our lawyers review each case to determine the right legal defenses. This may include researching and using applicable statutory loopholes and exceptions. For instance, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either lessen or entirely resolve a healthcare fraud case.
Defending your professional reputation. Allegations of healthcare fraud can damage your professional reputation. Oberheiden, P.C. will help protect your reputation both inside and outside the courtroom. Your Brownsville, Texas healthcare fraud defense attorney will correct misinformation presented to the public by the media about our clients. We also address slanderous comments.
If you’re being investigated by the federal government for healthcare fraud, call the law firm of Oberheiden, P.C. Ask to speak to an experienced healthcare fraud attorney. The initial call is free and confidential.
Our Track Record
The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Each Brownsville, Texas healthcare fraud defense lawyer has a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Healthcare Services Company against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged False Claims Act and Stark Law Violations.
Result: No civil or criminal liability.
- Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
Result: No civil or criminal liability.
- Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
Result: No civil or criminal liability.
- Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
Result: No civil or criminal liability.
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Including Weekends
Oberheiden, P.C.
Serving Brownsville, Texas and Surrounding Areas
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